Drug Use, Prisons and Compulsory Drug Treatment

Centers

Sonia Bezziccheri, UNODC Regional Centre for East Asia and the PacificThai Satellite Meeting

19 April, 2009

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Background

• In Thailand, drug offences account for the majority of people in prison

• An exponential increase in methamphetamine availability and use in the last ten years has placed further pressure on Thailand’s prison system

• In 2005, 65% of people in Thai prisons were on drugs related charges

• In 2006, 75% of the 68,000 drug-related arrests were methamphetamine related

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Prisons are overcrowded

The large numbers of drug users in prison has led to severe overcrowding

The National Rehabilitation Act was established in 2002 to divert drug users from prison

Drug users considered “patients, not criminals”

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Treatment Centers

Drug users increasingly sent to compulsory drug treatment centers (CDTC) “boot-camps” – there are currently 84 CDTCs in Thailand

75% of these centers are managed by the military or police

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Number of compulsory drug treatment centres is increasing

Year Thailand

2004 35 CDTCs

2005 49 CDTCs

2008 84 CDTCs

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A regional issue Incarceration of drug dependent people in

compulsory drug treatment centers is common

CDTCs Cambodia China Lao PDR

Myanmar Thailand Viet Nam

Number of CDTC

14 516 (as reported)

5 26 (major) and 40 (minor)

84 109

Population in CDTC

Unknown 140,000 Unknown 1,492 2,358 (adults)

3,500 (youth)

Approx. 100,000

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Implications for individual and public health

A history of incarceration has been associated with several negative health outcomes:

STIs including syphilis, herpes and HIV Mental health issues, skin infections TB Hepatitis B and C AIDS and TB are reportedly the major

cause of death

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Why?

Risk behaviours in prisons and CDTCs are prevalent:

Unprotected sex Tattooing Injecting drug use Penile modification “Fung Muk”

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The Facts

- Overcrowding - Limited availability of condoms- No availability of sterile needles/

syringes which leads to frequent sharing of equipment

- Under staffed and unqualified staff - Modest budget for HIV/AIDS services- Basic primary health needs are unmet

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Discussion A policy of confinement of drug users in

either prison or a CDTC is common in South East Asia:

- CDTCs are present in every country in the SE Asia , and number is increasing in most countries

- Lack of research on effectiveness/consequences of this policy

- Relapse is high - when reported

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Discussion cont’

No adequate provision of evidence based drug treatment for either opiate or methamphetamine dependence including harm reduction services

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Human Rights and Principles of Drug Treatment

Current approaches of confinement of drug users contravene:

1. the UN Covenants on Human Rights: The Right to the Highest Attainable Standard of Physical and Mental Health

2. WHO/UNODC Principles of Drug Dependence Treatment

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The concerns

No evidence that the drug treatment centers are in any way effective as relapse rates are very high

All necessary steps to prevent, treat and control epidemics (HIV particularly) are currently not being taken prisons and compulsory treatment centers

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Universal Access or

Access: Denied?

What are the human, economic and social costs of the CDTCs approach for individual, the community, the state?

What are the public health risks for confined drug users and the wider society?

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Recommendations

1. Research on health risks and vulnerability in both prisons and CDTCs is needed

2. Evaluation on effectiveness of CDTCs is necessary

3. Alternatives to imprisonment and confinement, including increased access to low threshold, voluntary, community and evidence based drug treatment options; and a comprehensive HIV/AIDS package of interventions for drug users

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Recommendations

4.Protect human rights of drug users5. Cease long period of detention without

trial and without access to health care especially for drug dependent people

6. Involve NGOs/civil society/families/affected community in the research; design, and implementation of responses

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Tools:

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Thank you

www.unodc.un.or.th/drugsandhiv/